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Hypothetical errors easier to 'confess' than real ones
Study: Most MDs say they'd disclose, but few have
While most doctors might feel good about the idea of disclosing medical errors to patients, a University of Iowa researcher says fewer than half of the physicians and medical students his team surveyed actually have disclosed real medical errors.
"To come in as the healer and then realize that you have harmed is a difficult thing to accept, let alone admit," finds Lauris Kaldjian, MD, PhD, director of the biomedical ethics and medical humanities program at the University of Iowa Carver College of Medicine in Iowa City.
In a survey of faculty physicians, resident physicians, and medical students, researchers found that while nearly all respondents indicated that they would disclose a hypothetical error, less than half reported having disclosed an actual minor or major medical error.1
While to a lay reader those figures might indicate that fewer than half of the 538 physicians, residents, and medical students had ever made a mistake, Kaldjian dismisses that interpretation.
"It seems fair to assume that all of us have made at least a minor error, if not a major error, sometime in our careers," he insists. Kaldjian acknowledges biases can influence survey data like this — for example, a respondent's reluctance to reveal information that may be embarrassing or unflattering.
The point remains, however, that there appears to be a discrepancy between how physicians and trainees believe they would act when faced with a medical error situation and how they have acted when in those situations, he continues.
"Our goal was to learn more about clinicians' attitudes but also what they actually have, and have not, done," Kaldjian explains. "We were interested in what factors or beliefs might be motivating physicians who are more likely to disclose errors to their patients."
Kaldjian and his colleagues asked questions about minor errors, such as "Have you ever made a mistake that prolonged treatment or caused discomfort and told the patient [or the patient's family] that a mistake was made?" and major errors, such as "Have you ever made a mistake that caused disability or death and told the patient [or the patient's family] that a mistake was made?"
The survey participants also were presented with a hypothetical case in which a physician failed to note a patient's allergy to cephalosporins and gave him one of the drugs to treat pneumonia. They were then asked how they would respond to each of three possible outcomes: no harm to the patient; minor harm (diffuse itching and a rash); or major harm (respiratory distress, anaphylactic shock, and myocardial infarction).
Ninety-seven percent of the faculty and resident physicians indicated that they would disclose the hypothetical medical error that resulted in minor medical harm (resulting in prolonged treatment or discomfort) to a patient, and 93% responded that they would disclose the error if it caused major harm (disability or death) to a patient.
However, only 41% of faculty and resident physicians reported actually having disclosed a minor medical error, and only 5% responded as having disclosed a major error. Moreover, 19% acknowledged having made a minor medical error and not disclosing it; 4% indicated having made and not disclosing a major error.
"Most doctors recognize that they're fallible, but they still strive for perfection and, for the most part, hold each other accountable to a high standard of practice that approximates perfection," Kaldjian notes.
Fear of malpractice has been cited as a reason why doctors do not disclose medical errors, but the study authors report that their survey found that physicians who had been exposed to malpractice litigation were not less inclined to disclose errors. The researchers also found differences among the survey respondents based on training level. Physicians with more experience were more willing to disclose medical errors, suggesting that with increased clinical competence and confidence, doctors become more comfortable with error disclosure, according to the study.
Kaldjian also noted preliminary survey data showing that physicians who indicated that forgiveness is an important part of their spiritual and religious belief systems were more likely to disclose medical errors to their patients.
"This is not to say that forgiveness should be a course in medical school," he says. "But it does suggest that medical schools should consider ways to encourage trainees to draw upon the deeper personal beliefs they bring to the practice of medicine that may be relevant to the challenges of disclosing medical errors."
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